Cognitive Behavioral Theories of Counseling

Psychology -- Cognitive theories

Use of the Session Bridging Worksheet in Cognitive Therapy

The purpose of the Session Bridging Worksheet is to assess the client's insight and comprehension of the prior therapy session (Beck, 1995). Being aware of the fact that they will be questioned concerning the previous session encourages the client to prepare for the present session by reflecting on the session throughout the week. If the client cannot remember their responses or the significant concepts from the prior therapeutic session, the counselor and client come together to figure out a way so that they can more effectively recall the elements of the present session. The Session Bridging Worksheet offers a way of getting this done. This is important because several studies have shown that increased memory and understanding of therapeutic sessions has a direct impact on treatment outcome (Shepherd, Salkovskis, & Morris, 2009). Also this technique requires that clients think about material discussed during previous sessions, which is also beneficial, as evidenced by countless studies, including one by Kazantzis, Deane, and Ronan (2000), which showed that therapist recommendations to clients to perform out-of-session actions were strongly related to positive psychotherapy outcomes.

Asking for additional responses to prior sessions might also extract essential therapeutic feedback by the client. This is significant, for Whipple et al. (2003) determined that a strengthened feedback condition, one in which therapists were given information regarding the client's assessment of the therapeutic relationship, motivation for change, and social support significantly improved treatment outcome. This "bridging" of the previous session also aids in the familiarization of the client to the cognitive therapeutic process, implying that they are equally accountable for examining the subject matter of each session, as well as for communicating any aversions they might have had to the previous session, which is important for studies show that feedback about poor treatment response to providers nearly doubled the number of clients who returned to a normal state of functioning (Lambert et al., 2002). Thus, the therapist being aware of possible negative responses to sessions by the client allows them the opportunity to explore and possible alter undesirable treatment modalities. Beck (1995) notes that a prime reason for patient's failure to recall session content is the therapist's failure to encourage the patient to write down the important points during the session itself. Difficulties in the utilization of the feedback typically have to do with the client's struggle to recall session matter or their hesitancy to voice criticism to the psychotherapist (Beck, 1995). The Session Bridging Worksheet offers a solution to this problem.

The therapist, thus, seeks to dispel or to reveal potential complications in a therapeutic session by examination of the client's comprehension, by requesting feedback, through the use of homework, and by dealing with supposed difficulties directly during the present session or during the following session.

However, it is important for the therapist to remember that this may not work the same for all clients. In fact, there is preliminary evidence to suggest that homework is considered less important in the treatment of delusions and hallucinations, physical problems, and sexual abuse (Kazantzis & Deane, 1999). Therefore, it was hypothesized that homework would be considered less important for cases involving delusions and hallucinations, physical problems, and sexual abuse as compared with other presenting problems.